Healthcare Provider Details

I. General information

NPI: 1255020608
Provider Name (Legal Business Name): MARYAM HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3453 CASTLE HILL DR
WOODBRIDGE VA
22193-5319
US

IV. Provider business mailing address

3453 CASTLE HILL DR
WOODBRIDGE VA
22193-5319
US

V. Phone/Fax

Practice location:
  • Phone: 240-869-9325
  • Fax: 571-589-0141
Mailing address:
  • Phone: 240-869-9325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ZEINAB M AHMED
Title or Position: DIRECTOR
Credential:
Phone: 240-869-9325